O IMPACTO DA APRENDIZAGEM INTERPROFISSIONAL NA PNEUMONIA ASSOCIADA À VENTILAÇÃO: IMPLEMENTAÇÃO DE BUNDLES EM UMA UNIDADE DE CUIDADOS INTENSIVOS

Ariele Pinto Coelho, Raquel Aparecida Monteiro e Vieira, Monica Aparecida Leite, Thabata Coaglio Lucas

Resumo


Objetivo: verificar o impacto dos bundles e o aprendizado interprofissional na prevenção de pneumonia associada à ventilação mecânica de uma unidade de terapia intensiva (UTI). Método: estudo quasi-experimental realizado em uma UTI de um hospital público de Diamantina, Minas Gerais. Foram incluídos neste estudo 56 profissionais que prestavam assistência direta a pacientes em ventilação mecânica. A coleta de dados ocorreu em três fases: pré-intervenção, que consistiu em observação direta e entrevista; intervenção, na qual o treinamento foi realizado por meio de simulações clínicas; e pós-intervenção, na qual foi avaliado o impacto das estratégias implementadas por observação direta. As diferenças entre os grupos pré- e pós-intervenção foram avaliadas pelo teste de McNemar. Foi utilizado um nível alfa de 0,05 definido a priori, e a correção de Bonferroni determinou significância estatística para o caso de comparações múltiplas. Resultados: após a intervenção, houve aumento da adesão à pressão endotraqueal do cuff (8,10%), interrupção diária da sedação (16,67%), e aspiração subglótica (18,75%). As associações entre categoria profissional versus ausência de aspiração, posicionamento da cabeceira da cama, frequência de higiene bucal, e tipo de higiene das mãos após a intervenção foram significativas (p < 0,0083). Conclusões: ainda existe uma lacuna a ser detectada na implementação do bundle e o impacto positivo gerado pelo conhecimento interprofissional, principalmente porque não é imediato, mas a longo prazo, para obter o feedback desejado.

Palavras-chave: Pneumonia Associada a Ventilação; Bundles de Assistência ao Paciente; Controle de infecção; Melhoria da qualidade; Vigilância em saúde pública; Unidades de Terapia Intensiva.

THE IMPACT OF THE INTERPROFESSIONAL LEARNING IN VENTILATOR-ASSOCIATED PNEUMONIA: BUNDLES IMPLEMENTATION IN AN INTENSIVE CARE UNIT

Objective: to verify the impact of the bundles and the interprofessional learning for the prevention of mechanical ventilation-associated pneumonia of an intensive care unit (ICU). Method: This was a quasi-experimental study performed in an ICU of a public hospital in Diamantina, Minas Gerais. Were included in this study 56 professionals who provided direct assistance to patients in mechanical ventilation. The data collection took place in three phases: pre-intervention, which consisted of direct observation and interview; intervention, in which training was performed through clinical simulations; and post-intervention, in which the impact of the strategies implemented through direct observation, was evaluated. Differences between pre and post groups were assessed using McNemar’s test. An alpha level of 0.05 set a priori was used, and a Bonferroni correction determined statistical significance for the case of multiple comparisons. Results: After the intervention, there was increased adherence to endotracheal cuff pressure (8.10%), daily interruption of sedation (16.67%) and subglottic aspiration (18.75%). It was significant (p < 0,0083) in the associations between the professional category versus non-aspiration, bed head positioning, oral hygiene frequency and the type of hand hygiene after intervention. Conclusions: There is still a gap to be detected in the bundle implementation and the positive impact generated by the inter-professional knowledge, mainly because it is not immediate but in the long term to obtain the desired feedback.

Keywords: Pneumonia, Ventilator-Associated; Patient Care Bundles; Infection Control; Quality Improvement; Public health surveillance;  Intensive Care Units.

EL IMPACTO DEL APRENDIZAJE INTERPROFESIONAL EN LA NEUMONÍA ASOCIADA A VENTILADORES: APLICACIÓN DE PAQUETES EN UNA UNIDAD DE ATENCIÓN INTENSIVA

Objetivo: verificar el impacto de los bundles y el aprendizaje interprofesional para la prevención de la neumonía asociada a la ventilación mecánica de una unidad de cuidados intensivos (UCI). Método: Este fue un estudio cuasi experimental realizado en una UCI de un hospital público en Diamantina, Minas Gerais. Se incluyeron en este estudio 56 profesionales que prestaron asistencia directa a los pacientes en ventilación mecánica. La recolección de datos se realizó en tres fases: pre-intervención, que consistió en observación directa y entrevista; intervención, en la cual se realizó entrenamiento por medio de simulaciones clínicas; y post-intervención, en que se evaluó el impacto de las estrategias de observación directa. Las diferencias entre los grupos pre y post se evaluaron mediante la prueba de McNemar. Se usó un nivel alfa de 0,05 a priori, y se usó una corrección de Bonferroni para determinar la significación estadística en el caso de comparaciones múltiples. Resultados: Después de la intervención, hubo aumento de la adhesión al monitoreo de la presión del cuff endotraqueal (8,10%), interrupción diaria de la sedación (16,67%) y aspiración subglótica (18,75%). Fue significativa (p < 0,0083) las asociaciones entre la categoría profesional frente a la no aspiración, la posición de la cabecera de la cama, la frecuencia de higiene oral y el tipo de higiene de las manos después de la intervención. Conclusiones: Aún existe una laguna a ser detectada en la implantación del bundle y el impacto positivo generado por el conocimiento interprofesional, principalmente por no ser inmediato, pero a largo plazo, para obtener el feedback deseado.

Descriptores: Neumonía Asociada al Ventilador; Paquetes de Atención al Paciente; Control de Infecciones; Mejoramiento de la Calidad; Vigilancia en Salud Pública; Unidades de Cuidados Intensivos

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DOI: https://doi.org/10.21675/2357-707X.2019.v10.n4.2262

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Este trabalho está licenciado com uma Licença Creative Commons - Atribuição 4.0 Internacional.